KCL MED Mock Exam 0304

Kings College London
GKT School of Medicine

UNI VERSI TY OF L ONDON

This paper is not part of an examination of the college counting towards the award of a degree.
Examinations are governed by the College Regulations under the authority of the Academic Board.

MB BS 5 MOCK EXAMINATION

GKT VIRTUAL CAMPUS

EXAM INSTRUCTIONS FOR CANDIDATES
(This is what you should expect to see in the end of year exams)

Time Allowed =3 Hours (This mock exam should take 2 hours to complete section A & B)

There are two sections within this exam paper; instructions & test numbers are given at the beginning of
each section. Please use a pencil to answer on the MCQ answer sheets.

A normal values sheet has been provided.

Candidate Number: last four digits of your official College candidate number
(eg. E01234 = 1234).
MCQ Test Number: (See beginning of each section)
College Number: 10

DO NOT REMOVE ANY PART OF THIS EXAM PAPER
FROM THE EXAMINATION ROOM

TURN OVER WHEN INSTRUCTED (Virtual Campus - when your ready!)

2003 Kings College, London MG5MB5
MBBS Part 5 Mock Exam - 2 - continued on next page
MB BS PART 5 EXAM

SECTION A

There are 75 questions in this section, which should be answered on the
MCQ answer sheet that has SINGLE CORRECT RESPONSE written
on the bottom left of the sheet.

Please complete the following details on the MCQ answer sheet on your desk:

Date: Day/Month/Year of exam
Name (please also write your desk number on this line)
Last four digits of your candidate number
Test number:
College number: 10

For each question you should mark ONE answer on the MCQ sheet
provided. Please do not make any other marks on the sheet.

SECTION A SINGLE BEST RESPONSE

1 An elderly man has severe headaches with a tender, red, inflamed temporal artery which has
prevented him from sleeping for weeks. He is beginning to feel unwell. His Hb is 10g/dl
and his ESR is 80mm/h. On the day he sees his GP he has blurring of the right eye. What is
the most appropriate therapy?
A Non steroidal anti-inflammatory agents
B Intra-venous corticosteroids
C Intra-venous penicillin
D Intra-venous immunoglobulins
E Methotrexate

2 A 70 year old otherwise fit woman presents with a short history of a painless swelling in the
left breast. Examination reveals a 2.5cm swelling, slightly irregular with overlying skin
dimpling and tethering. No nodes are palpable in the left axilla. What is the most likely
diagnosis?
A Fibroadenoma
B Duct ectasia
C Fibroadenosis with cyst
D Ductal carcinoma
E Traumatic fat necrosis

3 A large cohort study investigating the association of consumption of alcohol and stomach
cancer shows that those who drink more than 21 units of alcohol per week have a relative
risk of developing stomach cancer of 1.35 (95% confidence interval 1.10 to 1.75) compared
to those drinking 21 units or less per week. On the basis of this finding, which of the
following is true?
A Alcohol intake above 21 units per week causes stomach cancer
B The more people drink the more likely they are to get stomach cancer
C Countries with a high average alcohol intakes have a higher prevalence of stomach
cancer
D People who drink more than 21 units of alcohol per week are on average 13 times
more likely to develop stomach cancer than those who drink less
E There is a statistically significant increased risk of stomach cancer in those who
drink more than 21 units of alcohol per week

4 Which finding favours the diagnosis of motor neurone disease?
A Sensory loss
B Absent tendon reflexes
C Muscle fasciculation
D Muscle hypertrophy
E Optic atrophy

5 You are a GP. A 14 year old girl comes to your surgery requesting emergency contraception
(morning after pill). Which is the most appropriate course of action?
A You should give her the medication only if you are convinced she is able to make a
mature and responsible decision.
B You should give her the medication without question since it is available from the
GP on demand for any at-risk patient.
C You should not prescribe in this situation since it is illegal to do so without the
parents explicit consent.
D Your actions should take into account the legal rights of the unborn child
E You should warn her of her foolishness and make her an appointment with the
family planning clinic

6 A 25 year old man comes into Accident and Emergency with supraventricular tachycardia.
Carotid massage does not stop the attack which has already lasted three hours. He is
normally well and is on no medication and has no other illnesses. What medication is
preferentially used (treatment of choice) to stop the attack?
A Intravenous lignocaine
B Intravenous digoxin
C Intravenous amiodarone
D Intravenous adenosine
E Intravenous quinidine

7 An elderly woman falls in the ward and fractures the head of the left humerus. The fracture
is minimally
displaced and impacted. What is the most appropriate management?
A Collar and cuff
B Excision of the head of the humerus
C Pin and plate
D Replacement by an artificial head of the humerus
E Reduction and realignment under anaesthetic

8 A 19 year old female college student presents with a weeks history of severe fatigue, fever,
sore throat and swollen lymph nodes in the neck, axillae and groins. Physical examination
reveals symmetrical tonsillar enlargement with redness and exudate, petechiae on the palate
and an enlarged spleen. Investigations showed a haemoglobin of 12g/dl and a white blood
count of 4.6 x 10
9
/l with 56% segmented neutrophil forms, 20% lymphocytes, 26% atypical
lymphocytes and 4% monocytes. The platelet count is normal. What is the likely diagnosis?
A Acute lymphocytic leukaemia
B Streptococcal pharyngitis
C Infectious mononucleosis
D Herpes simplex virus infection
E Toxic shock syndrome

9 A 48 year old male is found through health screening to have repeatedly elevated blood
pressures of about 190/110mmHg. He has had several weeks of headaches, but denies any
chest pain or breathlessness. On examination he has a loud aortic second sound and a S4
(atrial) sound. His ECG shows abnormal voltage changes and ST segment depression in the
left ventricular leads. His urine contains 2+of protein. Optic fundi show grade II
hypertensive retinopathy. What would be the most appropriate management?
A Advise weight loss and see again in 2 months
B Arrange an exercise stress test
C Hospitalise and give urgent intravenous antihypertensive medication
D Begin oral hypotensives and see in 3 months
E Begin oral hypotensives and see in 2 weeks

10 A 27 year old woman presents with several weeks of polyuria, increased thirst and weight
loss. She denies urinary urgency or painful micturition. Her BP is 120/80mmHg.
Examination reveals decreased skin turgor, fungal infection of both feet and vaginal
candidiasis. What is the next appropriate diagnostic investigation?
A Full blood count
B Blood glucose
C Liver function tests
D Serum calcium
E Culture of the fungus

11 A patient has been commenced on a monoamine oxidase inhibitor drug for depression. He
presents to Accident and Emergency with a severe headache and vomiting. His blood
pressure is 200/110mmHg. He tells you that his dentist prescribed an opioid-containing
analgesic for a toothache. Which one of the following is the most likely diagnosis?
A Essential hypertension
B Migraine
C Psychological stress reaction
D Drug interaction
E Menieres disease

12 An elderly man has pneumococcal pneumonia and his temperature, while first subsiding,
returns and becomes swinging. His breathlessness and pleural pain intensify and he has a
high white blood cell count. The signs change from those of consolidation to those of a
pleural effusion. A chest x-ray confirms an effusion. What is the next appropriate test?
A CT scan
B Bronchoscopy
C Diagnostic pleural tap
D Pulmonary function studies
E Re-check the sputum for resistant organisms

13 A young man in his thirties has a heavy meal with alcohol and shortly after vomits and has
severe thoracic and epigastric pain. He becomes breathless and hypotensive. When seen in
Accident and Emergency he is noted to have subcutaneous emphysema in the root of the
neck on both sides and a left-sided pleural effusion. What intrathoracic catastrophe has
occurred?
A Ruptured lower oesophagus
B Tension pneumothorax
C Massive pulmonary infarct
D Dissecting aneurysm
E Cardiac infarction with rupture of free left ventricular wall

14 A young man is involved in a fight with knives. The front of his chest is penetrated, 2 cm
medial to the left nipple. He is brought to Accident and Emergency hypotensive, pale,
shocked, with a blood pressure of 80/60 mmHg, and a pulse rate of 130 beats per minute. On
sitting him up his venous pressure is markedly raised in spite of probable hypovolemia and
rises further on inspiration. What should be done next?
A Insertion of pulmonary catheter to measure wedge pressure
B Rapid intra-arterial transfusion of blood
C Pericardial drainage
D Insertion of central venous pressure line
E Measure cardiac enzymes to detect cardiac contusion

15 A child with acute leukaemia is treated with corticosteroids. Which infection, if the child is
unwittingly exposed to it, is a particular hazard?
A Rubella
B Chicken pox
C Scarlet fever
D Whooping cough
E Streptococcal pharyngitis

16 The National Service Framework for coronary heart disease is a:
A Document prepared by the local health authority to improve management of heart
attack patients
B Document prepared by the Royal College of Physicians to give guidance to
clinicians on the management of heart attack patients
C Document prepared by the National Health Service Executive outlining what is
expected of health authorities, primary care teams and trust in the prevention
treatment and rehabilitation of heart disease
D National audit of the management of coronary hear disease
E Guidance from the General Medical Council on how to maintain skills in the
management of heart disease

17 A man of 60 has progressive, painless, dysphagia with weight loss and a feeling of food
sticking in the chest. There are no physical signs. The following may all be helpful but
which is probably the most crucial test?
A Oesophageal manometry
B Oesophageal pH studies
C Oesophagoscopy and biopsy
D Barium swallow
E Chest x-ray

18 An obese woman has had intermittent retrosternal chest pain on swallowing food over many
years. A stricture is shown radiologically and is believed to be benign. What is the most
likely reason for this benign oesophageal stricture?
A Systemic sclerosis
B Medications (e.g. non-steroidal anti-inflammatory agents)
C Caustic induced (e.g. alkalis)
D Radiation
E Reflux oesophagitis

19 Which of the following is NOT seen as a complication of carcinoma of the lung
A Ptosis
B Hypertrophic pulmonary osteoarthropathy
C Hypocalcaemia
D Hyponatraemia
E Adrenal metastases

20 Symptomatic severe carotid stenosis causes strokes, transient ischaemic episodes and retinal
infarction. In such patients which screening test is advocated, initially, to determine those
who might be candidates for carotid endarterectomy?
A Magnetic resonance angiography
B Doppler duplex ultrasound
C Carotid angiography
D Positron emission tomography
E CT Scan

21 An elderly man has persistent rest pain in both feet. The pain is worse when in bed and he
gets relief by dangling his feet out of the bed. What do you suspect?
A Chronic venous obstruction
B Acute deep vein thrombosis
C Severe arterial occlusive disease
D Gout
E Neuropathy

22 A girl aged 13 has had a fight with her boyfriend and ingested 12 of her grandmothers
diazepam (10 mg) tablets. She is drowsy (GCS 12) and has a heart rate of 80 bpm and blood
pressure 110/50. Which of the following is the most appropriate therapy for her
A Intravenous flumazenil
B Observation without intervention
C Gastric lavage
D Activated charcoal
E Intravenous fluids

23 In the treatment of hypertension
A Alpha blockers such as prazosin are unlikely to cause postural hypotension
B Patients of Afro-Carribean descent respond well to ACE inhibitors
C ACE inhibitors are indicated if there is unilateral renal artery stenosis
D Treatment with bendrofluazide may result in hypokalaemia
E ACE inhibitors may cause ankle swelling as a side effect

24 A woman aged 50 years visits her GP because of a solitary painless lump in the left groin
noticed for several weeks. The lump is 2 cm in diameter and is situated below the inguinal
ligament and lateral to the pubic tubercle. The lump is firm, non-tender, immobile,
continuous with the deeper structures, has a cough impulse but is not reducible. What is the
likely diagnosis?
A Left indirect inguinal hernia
B Left direct inguinal hernia
C Left femoral hernia
D Enlarged lymph node
E Saphenous varix

25 In thyrotoxicosis which manifestation is more common in older than in younger patients?
A Goitre
B Tremor of the hands
C Atrial fibrillation
D Thyroid bruit
E Exophthalmos

26 An 85 year old man with a long history of intermittent constipation has had severe
constipation, abdominal pain and increasing abdominal distension for 3 days. Plain
radiographs of the abdomen show distension of the colon with a markedly dilated sigmoid
loop. Barium introduced via the rectum does not flow beyond the sigmoid where a tapering
obstruction is noted. The most likely diagnosis is
A Acute diverticulitis
B Volvulus of the sigmoid
C Irritable bowel syndrome
D Faecal impaction
E Ischaemic colitis


27 A worried man of 50 years presents to his GP with the complaint that he has passed bright
red stools intermittently for two months which streaks the stool, splashes the lavatory pan
and marks the toilet paper. This comes on either after straining at stool, or alternatively after
occasional bouts of diarrhoea. The bleeding is painless. What is probably the likeliest
cause?
A Haemorrhoids
B Anal fissure
C Carcinoma of the colon
D Colonic polyps
E Ulcerative colitis

28 A sexually active youth of 16 years presents to the Accident and Emergency department with
a 4 hour history of right testicular pain. He has vomited twice On examination he has
marked testicular tenderness and urinalysis shows no abnormality. The correct management
is:
A Further investigation with ultrasound to exclude a teratoma
B An abdominal x-ray because of the vomiting
C Urgent surgical exploration of the scrotum
D Admission and treatment with tetracycline for a probable sexually transmitted
disease
E Referral to the next urological outpatient clinic

29 A 60 year old asymptomatic man presents with a microcytic anaemia and a haemoglobin
level of 7g/dl. What is the most probable cause?
A Diverticulitis
B Cancer of the sigmoid colon
C Sickle cell anaemia
D Cancer of the pancreas
E Cancer of the caecum

30 An elderly woman falls and is unable to get up. On examination her right foot and leg are
externally rotated and the affected limb shows shortening. What fracture has occurred?
A Pelvic
B Ankle
C Shaft of the tibia
D Neck of the femur
E Shaft of the femur

31 Which one of the following is a particular problem after a recent stroke?
A Depression
B Hypomania
C Schizophrenia
D Social phobia
E Panic disorder


32 The diagnosis of urinary tract infections in young women is best confirmed by:
A Radiographic demonstration of the presence of ureterovesicular reflux
B The presence of pyuria
C Eliciting a medical history of recurrent fever and abdominal pain
D Ultrasonic examination of the kidneys and bladder
E Bacteriological culture of an adequately collected specimen of urine

33 Which is the most suggestive feature of infective endocarditis?
A Appearing and changing murmurs
B Erythema marginatum
C J uxta-articular nodes
D Atrial fibrillation
E Lymphadenopathy

34 Bronchial breathing characteristically occurs with:
A Basal emphysema
B Consolidation
C Pleural effusion
D Pneumothorax
E A raised diaphragm

35 A young adult presents with two days headache, fever, without any neck stiffness or focal
signs. He has widespread purpura over the trunk and limbs. He is gravely ill. What
investigation is most helpful?
A Lumbar puncture
B Blood culture
C Complete blood count
D Fibrin degradation products
E Plasma cortisol levels

36 A middle aged man presents with several months history of rib and spine pain. A skeletal
survey shows osteolytic lesions in the bones especially the skull. He is anaemic,
hypercalcaemic and in renal failure. An ESR is 100 mm/h and his serum alkaline
phosphatase is normal. There is no bony uptake on an isotope scan. What is his condition?
A Multiple myeloma
B Pagets disease
C Prostatic metastases
D Primary hyperparathyroidism
E Renal osteodystrophy

37 A young woman goes on holiday to the Caribbean. While there she develops a red scaly rash
on her nose and cheeks with arthralgia and fever. On her return to hospital she has chest pain
due to pericarditis. Pancytopaenia and proteinuria are discovered. What is the likely
diagnosis?
A Acute leukaemia
B Systemic lupus erythematosus
C Sarcoidosis
D Acute rheumatic fever
E Lyme disease

38 A man of 30 has been well apart from an operation for coarctation of the aorta in his teens.
While watching the TV he felt severe occipital pain and lost conciousness for a few minutes.
He recovered quickly but had pain down the spine into both legs. In Accident and
Emergency he is distressed because of pain, but is alert. He has a mild fever and his BP is
160/100mmHg. There is neck stiffness but no focal signs in the CNS. In the right fundus
there is a canoe-shaped subhyaloid haemorrhage. What is the most likely diagnosis?
A Massive intracerebral haemorrhage
B Subarachnoid haemorrhage
C Subdural haematoma
D Fulminating meningitis
E Hypertensive encephalopathy

39 Q waves in inferior myocardial infarction appear in which ECG leads?
A I and II
B II, III and aVf
C V1, 2 and 3
D I, aVf and V6
E V4, 5 and 6

40 An elderly man has been immobile for 3 weeks after a stroke. For 1 week he has been
restless and has increasing thin, watery, highly offensive stools leaking continually into the
bed. His abdomen feels lumpy and an abdominal x-ray shows a ground glass homogeneous
appearance in the pelvis. Spurious diarrhoea is suspected. What is the probable cause?
A Rectal prolapse
B Volvulus of the colon
C Faecal impaction in the rectum
D Pseudomembranous colitis
E Intestinal hurry from a high osmolar diet

41 A central venous line is being placed via the subclavian vein in an elderly man when he
suddenly becomes breathless and his oxygen saturation fails. What complication is most
likely to have happened?
A The wire has threaded into the left ventricle
B His chronic obstructive airways disease has been exacerbated
C A pneumothorax has been created
D A mycocardial infarction has been induced
E Air embolism has occurred

42 A man of 40 comes to Accident and Emergency complaining of a hot red, swollen, painful
knee joint and inability to walk. This should first be assumed to be due to:
A Crystal arthritis
B Septic arthritis
C Trauma
D A coagulation disorder
E Monoarticular rheumatoid arthritis


43 You are examining a patient in the coronary care unit and she suddenly becomes
unresponsive. There is no carotid pulse and the cardiac monitor shows ventricular
fibrillation. The first appropriate measure is:
A Sodium bicarbonate 50mg i.v. injection
B Defibrillation with 200 J oules
C One ampule injection i.v. of calcium chloride
D Paging (bleep) the ECG technician
E Carotid artery compression

44 In hospital surgical patients the most common cause of oliguric renal failure is
A Transfusion with mismatched blood
B Hypovolaemia
C Drug reaction
D Pre-existing renal disease
E Uncontrolled infection

45 A man of 30 years, previously well, has an attack of Herpes zoster and is discovered to have
a cluster of firm, mobile, enlarged lymph nodes (approximately 4 am in diameter) in his left
axilla. A full blood count shows leukocytosis, a haemoglobin of 12g/dl and an ESR of 40
mm/h. A provisional diagnosis of lymphoma is made. What is the next step in diagnosis?
A Lymph node biopsy
B Marrow aspiration
C Whole body scan
D Lymphangiogram
E Chest radiograph

46 A woman of 77 years has had an elbow joint replacement for severe rheumatoid arthritis.
After two weeks a purulent discharge occurs which grows Methicillin Resistant
Staphylococcus Aureus (MRSA). Which antibiotic therapy is advised?
A Nafcillin
B Vancomycin
C Cefuroxime
D Gentamicin
E Tetracycline

47 An elderly adult male patient has painless, repeated, profuse haematuria. This is most likely
to result from:
A Prostatitis
B Renal stone
C Renal tumour
D Bladder tumour
E Bacterial cystitis

48 A boy after a road traffic accident has a ruptured spleen which requires removal. What long
term hazard is he liable to?
A Venous thrombosis of the legs
B Repeated pneumococcal infections
C Cirrhosis with portal hypertension
D Polycythaemia
E Increased fragility of the skin following surgery

49 A middle aged woman has upper abdominal pain, jaundice and rigors for several days. Her
liver is tender and enlarged on palpation. A full blood count shows leukocytosis. What is
the likely diagnosis?
A Viral hepatitis
B Acute cholecystitis
C Acute cholangitis
D Pancreatic cancer
E Drug induced hepatitis

50 A middle aged woman loses weight, her abdomen becomes swollen and distended with fluid
and her umbilicus everted. Examination suggest a tumour and a diagnosis is made of
peritoneal carcinomatosis. This is most likely to be due to:
A Colonic cancer
B Pancreatic cancer
C Stomach cancer
D Ovarian cancer
E Hepatoma

51 A middle aged man with a long history of indigestion and recent NSAID (non-steroidal anti-
inflammatory drug) therapy is taken to the Accident and Emergency department because of
sudden postural syncope and a feeling of faintness. He is noted to be pale, perspiring and
hypotensive. His pulse is 120 per minute. Digital rectal examination reveals black tarry
stools. What is the most likely underlying diagnosis?
A Caecal carcinoma
B Colonic diverticulitis
C Angiodysplasia of the colon
D Bleeding peptic ulcer
E J ejunal ulceration


52 You are married with three children, and your partner works as a GP, and you work as a
surgical SpR.. Your partner has complained that you are coming home later and later, and
going into work on your days off to see if you can help the team with patients. Your partner
also tells you that you seem to be taking too much alcohol, although you only drink wine
with your evening meal. Which of the following is a reasonable and healthy response to this
difficult situation?
A You tell your partner that you are a dedicated and mature doctor, who needs
understanding, time but most of all space to dedicate to your work
B You row with your partner, and explain that your work comes first.
C You ignore your partner, and finish the bottle of wine before going to bed on your
own, because you have an early start the next day.
D You go into work to help the team who have trouble without you there
E You talk to your GP and ask for professional advice and help, because you are not
sure you understand what is happening.

53 An asthmatic comes into hospital with a sudden acute episode of breathlessness and wheeze.
She is not responding to nebulized salbutamol, inhaled steroids, intravenous aminophylline,
oxygen, hydration and antibiotics. Arterial blood gases are being monitored as well as her
vital signs in case she needs ventilating. What other measures are indicated for this young
woman?
A Intravenous corticosteroids
B Sedation
C Intravenous metronidazole
D Sodium cromoglycate
E Digoxin and diuretics

54 A known drinker, previously well, in his 30s presents in shock, with acute abdominal pain,
hyperglycaemia, hypocalcaemia, disseminated intravascular coagulation and renal failure.
He later develops non-cardiogenic pulmonary oedema (ARDS). What is the likely
diagnosis?
A Acute pancreatitis
B Peptic ulcer perforation
C Cholecystitis
D Leaking abdominal aorta
E Mesenteric thrombosis

55 A 17 year old girl presents with a foul smelling vaginal discharge. Speculum examination
reveals a foamy green-yellow discharge in the posterior fornix. She admits to a longstanding
relationship and is taking oral contraceptives. There are petechiae on the cervix. A wet
mount shows motile organisms. Her partner is asymptomatic. What is the most likely
organism involved?
A Candida albicans
B Gardnerella vaginalis. (Hemophilus vaginalis)
C Chlamydia trachomatis
D Trichomona vaginalis
E Beta haemolytic streptococcus


56 A woman with advanced metastatic breast cancer is admitted with vomiting, thirst,
constipation and drowsiness. A neurological examination and CT brain scan reveal no cause
for her deterioration. She improves following rehydration with intravenous 0.9% sodium
chloride. What metabolic condition is causing her problem?
A Hyperphosphataemia
B Hypercalcaemia
C Hyponatraemia
D Uraemia
E Hypermagnesaemia

57 A man of 50 years has crushing chest pain with sweating. He is taken to Accident and
Emergency within 1 hour of the onset. Which ECG change would lead you to initiate
thrombolytic therapy?
A Right bundle branch block
B ST segment elevation in left ventricular leads
C Widespread ST segment depression
D Q waves in septal leads
E Prolongation of the QT interval

58 A man of 60 years has refractory heart failure due to ischaemic myopathy in spite of digoxin
and diuretic therapy. Echocardiography reveals no surgically amenable valve disorder but
shows global dysfunction. Electrolyte levels and renal function are normal. What
medication should be tried next?
A ACE inhibitors
B Verapamil
C Disopyramide
D Phosphodiesterase inhibitors
E Propranolol

59 In the prevention of infective endocarditis which one of the following conditions strongly
warrants antibiotic prophylaxis in a patient about to visit a dentist for scaling?
A Atrial septal defect
B Ventricular septal defect
C Previous coronary artery by-pass grafting involving the use of the internal mammary
arteries
D Presence of a dual chamber pacemaker
E Previous pericarditis

60 A man with chronic renal failure is anaemic and the picture is one of normocytic
normochromic anaemia. What measures specifically improves the anaemia of chronic renal
failure?
A Corticosteroids
B Folic acid
C Vitamin B
12

D Iron
E Erythropoietin


61 A man with a history of alcoholism is admitted to hospital for an emergency
appendicectomy. On the third post-operative day he becomes confused, agitated and suffers
visual and auditory hallucinations. His hands are too unsteady to feed himself. The next day
he has a seizure. What is the most likely diagnosis?
A Delirium tremens
B Korsakoffs syndrome
C Wernickes encephalopathy
D Alcoholic hallucinosis
E Alcoholic intoxication

62 A patient prescribed a depot phenothiazine develops a mask-like face, tremor at rest, rigidity,
akathisia and a shuffling gait. What medication if given concurrently prevents these
extrapyramidal features?
A Levodopa
B Diazepam
C Procyclidine
D Carbamazepine
E Clomipramine

63 An elderly man, who does not drink alcohol, has mild chronic dementia. Abruptly his
condition worsens. His memory, attention and awareness of his surroundings deteriorates.
He no longer knows where he is, he hallucinates and becomes disturbed and distressed. He
is aggressive, hyperactive and unmanageable at home. What medication is given for
immediate action to calm him down while the doctors identify the reason for his
deterioration?
A Fluoxetine
B Haloperidol
C Diazepam
D Lithium
E Amylobarbital

64 Which of the following death certificates will NOT be accepted by the Registrar for Births
& Deaths
A 1a. bronchopneumonia
1b. carcinoma of the bronchus
B 1a. left anterior myocardial infarction
1b. coronary artery thrombosis
2. diabetes mellitus
C 1a. hyaline membrane disease
1b. prematurity
1c. abruption of the placenta
D 1a. haemoperitoneum
1b. traumatic rupture of the spleen
2. malaria
E 1a. heart failure
1b. aortic stenosis
1c. chronic rheumatic fever


65 A male diabetic aged 70 years normally controlled by a once daily long acting insulin is
admitted to hospital with acute cellulitis, fever and a urine loaded with sugar and ketones.
His blood sugar is 22 mmol/l. He is thirsty, incontinent, but is not vomiting and he can keep
down food and drink. What hypoglycemic agent is most suitable during this illness?
A An increase in long acting insulin
B Soluble human insulin
C Metformin
D An oral sulphonylurea
E A combination of metformin and a sulphonylurea

66 A young man of 20 years complains of chest pain worse on breathing 3 weeks after an upper
respiratory tract infection. He has no abnormal physical signs other than a fever and a
scratchy sound in systole and diastole. His ECG shows widespread ST segment elevation in
all leads except V1 and aVr with the concavity upwards. Serial ECGs show the ST
segments return to the base line and then the T waves start to invert. What does the clinical
picture suggest?
A Unstable angina
B Hyperventilation syndrome
C Pulmonary emboli
D Evolving cardiac infarction
E Acute pericarditis

67 A reduced ratio of forced expiratory volume in one second to forced vital capacity
(FEV
1sec
/FVC) is a characteristic finding in spirometry in what condition?
A Pleural effusion
B Diaphragmatic paralysis
C Chronic obstructive airway disease
D Pulmonary fibrosis
E Kyphoscoliosis

68 Which of the following investigations is covered by IR(ME)R 2000 legislation
A HIV screen
B Routine ultrasound
C CT head scan
D MRI scan of lumbar spine
E 24 hour ECG

69 For a patient with Diabetics the optional blood pressure must be under:-
A 130/90
B 130/80
C 140/80
D 150/70
E 145/85


70 A woman of 20 years with acute thyrotoxicosis is started on carbimazole. After 2 weeks she
develops a persistent and worsening sore throat with fever and mouth ulceration. What is the
first and most appropriate test that is required?
A Throat swab
B Paul Bunnell test
C Blood culture
D Serum immunoglobulins
E White blood cell count

71 The highest rate of suicide in the UK is seen with:
A Young women and teenagers
B Young men
C White elderly men
D Black elderly men
E White elderly women

72 Which of the following therapies does not require you to be a Registered Practitioner?
A Accupunture
B Occcupational Therapy
C Physiotherapy
D Chiropractology
E Reflexology

73 A 20 year old man sustained a minor head injury during a fight in the pub. He presents 24
hours later with marked ataxia, tremor, nystagmus, dysmetria and dysarthria. The best
course of action is to order
A A CT scan of head
B A lumbar puncture
C A period of observation
D An angiogram
E An EEG

74 A single girl of 16 has primary dysmenorrhoea with severe crampy, lower abdominal pain on
the first two days of her period which prevents her attending school. What should be the first
line of treatment?
A Danazol
B Mefenamic acid
C Combined oral contraceptive pill
D Dilatation and curettage
E Gonadotrophin releasing hormone analogue


75 Your patient is undergoing surgery to remove a breast mass (lumpectomy) which is
considered clinically to be benign. At operation you find that the mass is malignant and wish
to proceed to a mastectomy. Medico-legally you are justified in taking the following action
A You are ethically obliged to complete the mastectomy because this is in the patient's
best interests
B You should complete the mastectomy for humanitarian reasons to prevent
unnecessary pain
C You should obtain her partners consent to continue with the mastectomy
D You should complete the lumpectomy only and after she has recovered from this
procedure seek her written consent for a later mastectomy
E Benign paternalism dictates you should immediately do what is best for the patient
without distressing her further


MB BS PART 5 EXAM

SECTION B

There are 25 questions in this section, which should be answered on the
MCQ answer sheet that has EXTENDED RESPONSE A written on the
bottom left of the sheet.

Please complete the following details on the MCQ answer sheet on your desk:

Date: Day/Month/Year of exam
Name (please also write your desk number on this line)
Last four digits of your candidate number
Test number:
College number: 10

SECTION B EXTENDED MATCHING

1 Extended matching MCQ Public Health Theme: study design

A cross-sectional study E controlled study
B cohort study F migrant study
C case control study G randomised controlled trial
D ecological study H none of the above

For each of the following situations select the most appropriate study design. Each option can be
used once, more than once or not at all.

1 (i) 1000 women with cervical cancer and 1000 age-matched women without cervical cancer
are interviewed about their smoking history to study the connection between cervical cancer
and smoking.

2 (ii) Patients with gonorrhoea are given either multiple or single-dose antibiotic therapy to
evaluate the effectiveness of single dose therapy in the treatment of gonorrhoea.

3 (iii) One hundred patients with peripheral vascular disease treated by vein grafting (50 who
continue to smoke and 50 who have stopped smoking) are followed for 5 years to compare
the incidence of graft occlusion in the two groups.

4 (iv) Rubber industry workers are surveyed regarding their health status and medical problems to
determine the prevalence of occupational illnesses in various job groups.


2 Extended matching MCQ General Practice
The following conditions may cause patients to behave abnormally in the community

A alcohol withdrawal F hypothyroidism
B Alzheimers disease G hypoxia
C depression H schizophrenia
D hypoglycaemia I steroid psychosis
E hypomania J temporal lobe epilepsy

As a general practitioner you are asked to visit the following patients. Select the one most likely
working diagnosis:

5 (i)

The family of a 70 year old woman are concerned by a slow deterioration in her condition
over the past few months. She has become paranoid and is accusing them of trying to
poison her. She is very lethargic and, since you last saw her 6 months ago, has put on
weight noticeably.

6 (ii)

A neighbour reports that Mr Thomas, a 75 year old patient of yours, has been found
wandering in the streets. His wife died suddenly two months ago. When you visit him at
home, he is clearly disorientated and doesn't recognise you.

7 (iii)

The daughter of a 79 year old woman, who was widowed 9 months ago, reports her mother
is behaving oddly. She is very withdrawn and has become paranoid about the people in the
flat opposite her whom she believes are spying on her. She has lost all motivation and
rarely ventures out of the house.

8 (iv)

A patient of yours asks you to visit her 22 year old son who is home from university. He
has become abusive and is accusing them of trying to steal his money. He is hyperactive
and refuses to sleep, pacing the house all night. He is not on any medication.


3 Extended matching MCQ Medicine Theme: cough

A acute bronchitis F primary lung carcinoma
B asthma G pulmonary embolism
C chronic obstructive pulmonary
disease
H sarcoidosis
D cystic fibrosis I tuberculosis
E pneumonia J viral pleurisy

Select the diagnosis most appropriate for each clinical vignette. Each option may be used once,
more than once or not at all.

9 (i) A 59 year old man has had cough productive of blood-tinged sputum for eight hours. He
has had temperatures to 38.9
o
C, malaise, shortness of breath, and a cough productive of
yellow phlegm for two days. He has smoked two packs of cigarettes daily for forty years.
Rhonchi, wheeze and crepitations are heard over the right hemi-thorax. An xray film of the
chest shows a dense lobar infiltrate in the right hemithorax.

10 (ii) A 25 year old man has had a cough productive of blood-streaked sputum for five days. Over
the past six years he has had similar symptoms once or twice annually that have been
successfully treated with antibiotic therapy. He has had a cough for twelve years, recently
productive of one to two cups of yellow-green sputum daily. He does not smoke. He is an
insulin-dependent diabetic and takes pancreatic extracts. Coarse rhonchi bilaterally and
wheeze are heard. An xray film of the chest shows increased interstitial markings
bilaterally, nodular lesions and hyper-inflation.

11 (iii) A 47 year old woman has had a cough productive of scant amounts of yellow phlegm and
temperatures to 38.3
o
C for three months. On one occasion the phlegm was blood-streaked.
She has had a 10 kg weight loss over the past four months. She does not smoke. She
immigrated from Vietnam twenty years ago and medical records are unavailable. Coarse
upper lobe crackles and rhonchi are heard bilaterally. An xray film of the chest shows
multiple, bilateral, upper lobe cavities with surrounding infiltrates of the lungs.

12 (iv) A 32 year old woman has suffered from an unproductive cough for three months, the onset
of which she dates to a holiday in Tunisia. She notices her cough after climbing stairs to
work. The cough is particularly troublesome at night and she has been self-medicating with
cough linctus. Her only other medication is the oral contraceptive pill. She is not
particularly troubled by breathlessness. On examination she is apyrexial and has no
abnormal physical signs in her chest.

13 (v) A 34 year old Afro-Caribbean gentleman has become progressively more breathless over the
past two months. His symptom of breathlessness is complicated by an unproductive cough,
most noticeable on exertion. He works as a mortuary attendant, smokes between 5-10
cigarettes per day and drinks no alcohol. He received BCG at school. His only other
complaints are of occasional recent irritation of the eyes and of right upper quadrant
abdominal discomfort. The physical examination is unremarkable, spirometry reveals
FEV1\FVC was 3.4\3.7 litres (predicted 3.8\4.6 litres), and liver function tests were mildly
elevated.


4. Extended matching MCQ Surgery Theme: rectal bleeding

A anal fissure F irritable bowel syndrome
B angiodysplasia G ischaemic colitis
C diverticular disease H rectal carcinoma
D duodenal ulcer I ulcerative colitis
E haemorrhoids


14 (i) A 19 year old boy with a history of diarrhoea and weight loss over the past year. Three
months previously he developed a perianal abscess. He has noticed blood mixed in with his
stool and is opening his bowels 8 times a day.

15 (ii) A 34 year old woman with pruritus ani but no pain on defecation, who has noticed spots of
bright red blood on the toilet paper after opening her bowels.

16 (iii) A 72 year old gentleman who has opened his bowels five times over the last 24 hours, each
time passing several cupfuls of bright red blood. He is starting to feel light-headed, has a
pulse of 96bpm, an Hb of 8g/dl, WCC of 10x10
9
/l, platelets 325x10
9
/l. He had a barium
enema three weeks previously which was reported as normal.

17 (iv) A 50 year old man who has suffered increasingly with tenesmus and constipation over
the past year and has lost 1 stone in weight. He has noticed bright red blood coating
the stool.

5. Extended matching MCQ Surgery Theme: abdominal mass

A abdominal aortic aneurysm F hepatomegaly
B appendix mass G incisional hernia
C bladder (retention of urine) H rectus sheath haematoma
D caecal carcinoma I sigmoid carcinoma
E empyema of gall bladder J splenomegaly


18 (i) A 21 year old man who reports fever, anorexia, nausea and poorly localised abdominal pain
one week ago. He now complains of right sided abdominal pain.

19 (ii) An 88 year old man who is hypertensive, and a life-long smoker arrives in casualty after
collapsing at home with a pulse of 100 and blood pressure of 60/30.

20 (iii) A 63 year old obese woman who had a previous perforated duodenal ulcer now presents
with a non-tender, central abdominal mass which disappears on lying flat

21 (iv) A 25 year old rugby player who suddenly developed pain in his right iliac fossa, which
worsens on movement.


6. Extended matching MCQ ENT Theme: hearing loss

A acute labyrinthitis F middle ear effusion
B acute suppurative otitis media G otosclerosis
C chronic suppurative otitis media-
tubotympanic type
H presbyacusis
D cholesteatoma I tympanic membrane perforation
E Meniere's syndrome J wax in the ear canal


22 (i) A 65 year old man is seen in the ENT outpatients with a history of progressive hearing loss
in the right ear associated with a scanty offensive ear discharge. Examination shows a crust
in the attic region. The Rinne test is negative in the right ear but positive in the left ear. The
pure tone audiogram shows bilateral high frequency hearing loss but in addition there is a
right-sided conductive hearing loss.

23 (ii) A 28 year old lady complains of deafness following an upper respiratory tract infection three
months ago. Examination includes a pure tone audiogram, which shows a bilateral
conductive hearing loss and flat tympanograms.

24 (iii) A 32 year old woman has had three attacks of acute rotatory vertigo associated with a
hearing loss and tinnitus. The hearing loss and tinnitus resolved between attacks. On
examination in the ENT Clinic there is little to find.

25 (iv) An 80 year old man complains of a progressive hearing loss for several years. Examination
of the ears shows normal tympanic membranes on both sides. The pure tone audiogram
shows a bilateral high frequency hearing loss.

End of Exam Paper

NORMAL VALUES

ESR 1-15 mm/hr
CRP <7 mg/l
Hb 12-16g/dL
MCV 80-100fl
MCH 27-32pg
PCV (haematocrit) M:0.4-0.5l/l F:0.36-0.47l/l
WBC 4.5-11.0 x 10
9
/L
neutrophils 2-7.5 x 10
9
/L
lymphocytes 1.2-3.5 x 10
9
/L
monocytes 0.4-1.0 x 10
9
/L
eosinophils 0.01-0.4 x 10
9
/L
basophils 0-0.01 x 10
9
/L
platelets 150-400 x 10
9
/L
reticulocytes 40-130 x 10
9
/L: <3%
plasma fibrinogen 2-4 g/l
HbA
2
level 1.5% - 3.5%
INR 0.8-1.1
APTT 0.8-1.2
serum sodium 135-145 mmol/l
serum potassium 3.5-5 mmol/l
serum chloride 98-107 mmol/l
serum bicarbonate 22-32 mmol/l
serum calcium 2.12-2.65 mmol/l
serum phosphate 0.8-1.5 mmol/l
blood urea 3.7-7.2 mmol/l
serum creatinine 60-110 mol/l
blood glucose 3.3-5.5 mmol/l
total serum protein 64-86 g/l
serum albumin 35-46 g/l
serum bilirubin <22 mol/l
serum alanine transaminase <55 IU/l
serum alkaline phosphatase 38-126 IU/l
serum gamma glutamyl transpeptidase 8-78 IU/l
serum amylase <200 U/l
serum thyroxine 60-135 mol/l
free thyroxine 9-20pmol/l
serum TSH (thyroid stimulating hormone) 0.3-5.5 mU/l
serum salicylate <10 mg/l
serum prostate specific antigen 0-4.5 g/l: 0-4.5ng/ml
serum cholesterol 3.9-5.5mmol/L
HDL-cholesterol <1.2mmol/L
serum triglyceride 0.55-1.9mmol/L
pH 7.35-7.45
PaO
2
10.6-14.6 kPa
PaCO
2
4.8-6.2 kPa
Arterial blood [H
+
] 35-45 nmol/L
Arterial blood derived [HCO
3
-
] 22-26 mmol/L
oxygen saturation >96%
CSF protein 0.15-0.4 g/l
CSF leukocytes/mononuclears <5 per cu mm
24 hour urinary protein <200mg
serum alpha-fetoprotein <10kU/l
serum carcinoembryonic antigen <10g/l
serum human chorionic gonadotrophin <5 IU/l
serum Ca125 <35U/l
serum Ca19-9 <33U/l
Peak expiratory flow rate (PEFR) 380l/min
Forced expiratory volume in 1 sec (FEV1) 2.4l
FVC 3.0l
body mass index 22kg/m
2

KCL MED Mock Exam 0304

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